Recently, the University of Iowa Breast Imaging Center was designated as an American College of Radiology (ACR) Breast Imaging Center of Excellence. Laurie Fajardo, MD head of the Department of Radiology at University of Iowa Hospitals and Clinics, talks about this designation and what it means:
What is the American College of Radiology?
The American College of Radiology is a national, medical association—similar to the American College of Cardiology or the American College of Family Medicine—whose members are radiologists. These specialized physicians perform medical imaging, so they’re the physicians who interpret x-rays, MRIs, CTs, and ultrasounds.
What steps does it take to be designated a Breast Imaging Center of Excellence?
The American College of Radiology began accreditation programs for various aspects of equipment and technology used in medical imaging. One of their starship accreditation programs focuses around mammography and centers that perform breast cancer screening. That program has been around for 15 to 20 years. It is based on a facility having modern, current, state-of-the-art mammography imaging systems, and also regular testing on these systems.
There are tests that are done every day, another set of are done once a week, some are done monthly, and some are checked every six months. You have to perform all these tests and have the system passed in order to have your system be approved.
You have to use technologists who:
- Are specially trained to perform mammograms
- Perform a certain volume of mammograms every month
- Have continuing medical education in mammography over three-year periods of time
The final aspect of the mammography accreditation program concerns radiologists. Radiologists are the doctors who interpret the mammograms. In order to be qualified to interpret a mammogram, they have to have undergone certain specialized training, most often during their radiology residency training, and they have to interpret a certain number of mammograms monthly and over a 12-month period. They also have to have a certain number of hours of continuing medical education over three-year periods or blocks of time. So over three years’ time, a radiologist has to have had 12 hours of continuing medical education in mammography in order to stay certified.
The Breast Imaging Center of Excellence goes beyond just mammography and looks at all the other things that are done in a breast center. We also do ultrasound imaging, and we do the same test steps with our ultrasound machine. The machine has to be tested, it has to be current, and we have to do regular testing. The technologists have to:
- Be trained and certified to perform breast ultrasound
- Do a certain number of breast ultrasounds each month to have enough experience
- Undergo additional education
The same for the radiologists—training, continuing education, and then the experience of reading high volumes of breast ultrasounds in order to be accredited in breast ultrasound imagining. It is the same for breast MRI—the machine, the technologists, and the radiologists. Those cover the three main areas of imaging that’s done on the breast.
Most breast centers also perform biopsies. If you want to be a center of excellence, you have to also be certified and accredited in the two types of biopsies most commonly performed on the breast using imaging.
These are nonsurgical, noninvasive biopsies. They are either:
- X-ray guided—called stereotactic biopsy
- Ultrasound-guided biopsy places a special probe or needle through the breast without a surgical incision and samples lesions that could be cancerous
To become a Breast Imaging Center of Excellence, the center must have:
- The same accreditation standards for biopsy in terms of the equipment
- The technologists that assist in the procedures
- The physicians. It’s important the physicians who do the biopsies do a certain volume of biopsies—not just one or two a year—but a volume that keeps them competent.
If you’re able to meet the standards and the criteria for procedures in imaging, then you can apply for accreditation to become designated as a Breast Imaging Center of Excellence. The accreditation is good for one year. We have to continue to send updated information annually to the American College of Radiology in order to stay designated as a center of excellence.
How many other centers in Iowa are designated as a Center of Excellence?
Currently, there aren’t any others. The criteria are fairly stringent and you need to do enough of these studies to be excellent, to be a center of excellence. University of Iowa Hospitals and Clinics is the only designated Breast Imaging Center of Excellence in Iowa.
How has breast imaging improved in the past five years?
Tremendous improvements primarily triggered by digital mammography, which has become commonplace in Iowa, although many practices are not completely digital. A high percentage of practices performing mammographies in Iowa have upgraded their equipment to digital mammography. Digital mammography has been shown, in a large national trial, to be superior in detecting breast cancer in certain breast populations. These are the populations we always had difficulty with in the past—young women, women with very dense breast tissue, women who are premenopausal or peri menopausal.
We weren’t as accurate with older women when we used the old film-based mammograms, and this has been dramatically improved with digital mammography. The other thing that has been an improvement has been the development of better imaging of the breasts using MRI. The American Cancer Society recommends that for certain women at a certain risk level—and this is above a 20 to 25 percent lifetime risk of breast cancer, and this is based on whether you carry a gene for breast cancer or you have a strong family history of breast cancer—that those women also have MRI added to mammography either once a year or every other year when they’re being screened for breast cancer.
How important is early detection of breast cancer?
Early detection of breast cancer, I think, is widely accepted as very critical. If we can find cancer, using imaging, in women who have no symptoms and who do not have a lump that can be felt—before it’s palpable—we can achieve nearly 99 percent cure rates and very long-term survival after diagnoses of breast cancer. As long as we can find things when it’s at 1.5 centimeters or smaller, the chance for cure is really tremendous.
What are the current guidelines for women to receive mammograms?
We begin screening the average woman at the age of 40 and perform annually breast cancer screens with mammography; if, for some reason, the woman has a strong family history, we’ll start to screen with mammography earlier than the age of 40. |
